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Should we pay people to look after their health?

 

http://theconversation.com/should-we-pay-people-to-look-after-their-health-24012

Should we pay people to look after their health?

The key to using incentives may be to do so with a high enough frequency to create healthy habits. Health Gauge/Flickr, CC BY-SA

With the Tony Abbott government expressing concern about the growing health budget and emphasising personal responsibility, perhaps it’s time to consider some creative ways of curbing what Australia spends on ill health. One solution is to pay people to either get well or avoid becoming unwell in the first instance.

The United Kingdom is already doing this kind of thing with a current trial of giving mothers from disadvantaged suburbs A$340 worth of food vouchers for breastfeeding newborn babies. And from January 1 this year, employers in the United Statescan provide increasingly significant rewards to employees for having better health outcomes, as part of the Affordable Care Act.

But should people really be paid to make healthy choices? Shouldn’t they be motivated to improve their health on their own anyway?

Encouraging right decisions

People don’t do what’s in their best interest in the long term for many reasons. When making decisions we tend to take mental short cuts; we allow the desires and distractions of the moment get in the way of pursuing what’s best.

One such “irrationality” is our tendency to focus on the immediate benefits or costs of a situation while undervaluing future consequences. Known as present bias, this is evident every time you hit the snooze button instead of going for a morning jog.

Researchers have found effective incentive programs can offset present bias by providing rewards that make it more attractive to make the healthy choice in the present.

Research conducted in US workplaces, for instance, found people who were given US$750 to quit smoking were three times more successful than those who weren’t given any incentives. Even after the incentive was removed for six months, there was still a quit rate ratio of 2.6 between the incentive and control groups – 9.4% of the incentive group stayed cigarette-free versus only 3.6% of the control group.

A refined approach

Still, while research on using financial incentives to encourage healthy behaviours is promising, it isn’t as straightforward as doling out cash in exchange for good behaviour.

Standard economic theory posits that the higher the reward, the bigger the impact – but this is only one ingredient to success. Behavioural economics shows that when and how you distribute incentives can determine the success of the program.

Here are a few basic principles to consider. First, small rewards can have a big impact on behaviour if they’re provided frequently and soon after the healthy choice is made. We have found this to be true in the context of weight-loss programs, medication adherence, and even to quit the use of drugs such as cocaine.

Games of chance are an effective way of distributing rewards as research has found people tend to focus on the value of the reward rather than their chance of winning the prize. Many people think that a 0.0001 and a 0.0000001 chance of winning a prize are roughly equivalent even though in reality they are vastly different probabilities.

Finally, people are more influenced by the prospect of losses than by gains. Studies show people put much greater weight on losing something than gaining something of a similar value.

In one weight-loss experiment, for instance, participants were asked to place money into a deposit account. If they didn’t achieve their weight goals, the money would be forfeited, but if they were successful, the initial deposit would be doubled and theirs to keep.

Reluctant to lose their deposits, participants in the deposit group lost over three times more weight than the control group, who were simply weighed each month.

Creating good habits

Incentives are particularly effective at changing one-time behaviours, such as encouraging vaccination or attendance at health screenings. But with increasing rates of obesity and other lifestyle-related diseases, we need to focus on how incentives can be used to achieve habit formation and long-term sustained weight loss.

We know financial incentives can increase gym usage and positively impact weight, waist size and pulse rate, but how to sustain gym use after the incentive is removed? The key may be to use incentives to achieve a high frequency of attendance for long enough to create a healthy habit.

We also need to consider how we can leverage social incentives, such as peer support and recognition, together with new technologies to maximise the impact of incentive-based programs.

Innovative solutions, like paying people to encourage the right health choices, may help to reduce both the health and economic impact of Australia’s growing burden of disease.

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Okham’s Razor – Limits to Growth – Kerryn Higgs

“The conscience and intelligent manipulation of the masses is an important element in democratic society. Those who manipulate this unseen mechanism constitute an invisible government that represents the true ruling power of our country. It is they who pull the wires that control the public mind.” Edward Bernaise (Sigmund Freud’s Cousin, Founder of modern PR)

http://www.abc.net.au/radionational/programs/ockhamsrazor/limits-to-growth/6088808

Limits to growth

Sunday 15 February 2015 7:45AM

IMAGE: IT IS IMPOSSIBLE FOR POPULATIONS AND ECONOMIES TO GROW WITHOUT LIMIT (GETTY/MARK EVANS)LINK TO LARGER IMAGE.

Australian writer Dr Kerryn Higgs has written a book called Collision Course – Endless Growth On A Finite Planet, in which she examines how society’s commitment to growth has marginalized scientific findings on the limit of growth, calling them bogus predictions of imminent doom.

Transcript

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Robyn Williams: Growth or no growth? You may have heard Dick Smith on Breakfasta couple of weeks ago saying that unlimited growth is impossible and we must do something else. But what? There is, of course, a way of improving what we do more efficiently and stopping waste. Peter Newman from Perth gave an example on Late Night Live late last year: If we used trains instead of trucks for freight, it would halve the costs and save many, many lives. We don’t do it because we always do what we’ve always done. Kerryn Higgs, who’s with the University of Tasmania, has just brought out a book called Collision Course – Endless Growth on a Finite Planet, published by MIT Press and she has recently been appointed a Fellow of the International Centre of the Club of Rome.

 

Kerryn Higgs: I came across The Limits to Growth quite by accident in 1972, just when it was published. It was commissioned by the Club of Rome and written by a team of researchers at MIT, led by Donella and Dennis Meadows. The book changed the way I thought about Nature, people, history, everything. It persuaded me that physics matters, and that the idea of ever-expanding economic growth is a delusion. Up to then, I was a mainstream humanities person, history being my main discipline, and writing my passion. I did grow up in the countryside and loved the natural world, but I had no real intuition of an impending environmental crisis. And here was this little book suggesting that if we carried on with our exponential expansion, our system would collapse at some point in the middle of the 21st century.

 

Although galloping economic growth already seemed normal to most younger people living in the developed world in 1972, the growth that took off after WW2 was not normal. It is absolutely unprecedented in all of history. Nothing like it has ever occurred before: large and rapidly growing populations, accelerating industrialisation, expanding production of every kind. All new. The Meadows team found that we could avoid collapse if we slowed down the physical expansion of the economy. But this would mean two very difficult changes— slowing human population growth and slowing the entire cycle of physical production from material extraction through to the disposal of waste. The book was persuasive to me and I expected its message to have an impact on human affairs. But as the years rolled by, it seemed there was very little—and then, even less. In fact, I gradually became aware that most people thought “the Club of Rome got it wrong” and scorned the book as an ignorant tract from “doomsters”, an especially common view among economists. I want to point out, though, that recent research from Melbourne University’s Graham Turner, shows that the Meadows team did not get it wrong. Their projections for what would happen if we carried on business as usual tally almost exactly with what has actually occurred in the 40 years since 1972.

 

But while scientists from Rachel Carson onwards sounded alarm about numerous problems associated with growth, this was not the case in our govern­ments, bureaucracies, and in public debate, where economic growth was gradually being entrenched as the central objective of collective human effort. This really puzzled me.

 

How come the Club of Rome got such a terrible press?

 

How did scientists lose credibility? When I was young, science was almost a god. A few decades later, scientists were being flippantly brushed aside.

 

How did economists displace scientists as the crucial policy advisors and the architects of public debate, setting the criteria for policy decisions?

 

How did economic growth become accepted as the only solution to virtually all social problems—unemployment, debt and even the environmental damage growth was causing?

 

And how did ever-increasing income and consumption become the meaning of life, at least for us in the rich world? It was not the meaning of life when I was young.

 

Answering these questions took me back through human history. A few developments were especially decisive.

 

Around 1900, the modern corporation emerged. Over just a decade or two, many of the current transnationals came into being in the US (with names like Coca Cola, Alcoa and DuPont). International Harvester amalgamated 85% of US farm machinery into one corporation in just a few years. Adam Smith’s free enterprise economy was being transformed into something very different. A process of perpetual consolidation followed and by now, frighteningly few corporations control the majority of world trade and revenue, giving them colossal power. The new corporations of the early 20thcentury banded together into industry associations and business councils like the immensely influential US Chamber of Commerce, which was formed out of local chambers from across the country in 1912. These organisations exploited the newly emerging Public Relations industry, launching a barrage of private enterprise propaganda, uninterrupted for more than a century, and still very healthy today. Peabody coal, for example, recently signed up one of the world’s PR giants, Burson-Marsteller, for a PR campaign to convince leaders that coal is the solution to poverty.

 

Back in 1910 universal suffrage threatened the customary dominance of the business classes, and PR was an excellent solution. If workers were going to vote, they’d need the right advice. No-one expressed it better than Edward Bernays, Freud’s nephew, who is credited with founding the PR industry. Bernays was candid:

 

The conscious and intelligent manipulation of the… masses is an important element in democratic society (he wrote). Those who manipulate this unseen mechanism … constitute an invisible government which is the true ruling power of our country… It is they who pull the wires which control the public mind.

 

PR became an essential tool for business to consolidate its power right through the century, culminating in the 1970s project to “litter the world with free market think tanks”. By 2013, there were nearly 7,000 of these, all over the world; the vast majority were conservative, free market advocates, many on the libertarian fringe, and financed by big business. They cultivate a studied appearance of independence, though one think tank vice-president came clean. “There is no such thing as a disinterested think tanker,” he said. “Somebody always builds the tank, and it’s usually not Santa Claus or the Tooth Fairy.” Funding think tanks is always about “shaping and reshaping the climate of public opinion”.

 

Nonetheless, the claim to independence has been so successful that most think tanks have tax-free charity status and their staff constantly feature in the media as if they were independent and peer-reviewed experts.

 

Another decisive development was the “bigger pie” strategy. Straight after World War 2, governments took on a new role of fostering growth. The emphasis increasingly fell on baking a bigger pie, so the slices could get bigger but the pie would not have to be divided up any more equitably. Growth could function as an alternative to fairness. Thorny problems like world poverty were designated growth problems and leaders in the decolonising world often embraced a growth-oriented version of development, a version that rarely helped their poor majorities. Growth allowed the privileged to maintain and even extend their opulence, while professing to be saving the world from poverty. It’s frequently claimed that growth is lifting millions out of poverty. But, apart from China, this is not really the case. China has indeed decreased the numbers of its extreme poor, though this has been achieved with disastrous environmental decline and increasing inequality.

Meanwhile, progress is patchy elsewhere. After 70 years of economic growth, with the world economy now 8 to 10 times bigger than it was in 1950, there are still 2 and a half billion people living on less than $2 a day, more than a third of the people on earth, and about the same number as in 1981. Growth has not been shared. Underlying the popularity of growth, there’s a great clash of values between mainstream economics and the physical sciences.

 

Economists see the human economy as the primary system—odd when you consider that the planet’s been here for about 4.6 billion years, and life for something like 3.8 billion.  The human era is less than a whisker on this timescale, but for economists Nature is just the extractive sector of their primary system, the economy. For scientists and ecological economists, the primary system is the planet – and it’s self-evidently finite. The human economy with its immense material extraction and vast waste, exists entirely within the earth system. Self-evident as these boundaries might seem, they remain invisible or contested in mainstream economics and are of little concern to politicians or citizens in most countries. Hardly a news bulletin goes by without stories of growth expected, growth threatened, or growth achieved. Growth is the watchword of both major parties here and around the world and remains the accepted solution to poverty, pollution and debt.

 

And yet, however necessary growth is to our current economic arrangements, and however desirable from the point of view of our expectations of material well-being and comfort, it’s hardly a practical aim if it’s based on a misperception of reality.

 

While we assume that a high and increasing level of material consumption is normal and desirable, we ignore the peculiarity of our times and the encroaching threats to us and our planet.

 

We are well into dangerous territory in three areas:

 

Firstly, species are going extinct 100 to 1000 times faster than the background rate.

 

Secondly, the nitrogen cycle is completely disrupted. In nature, nitrogen is largely inert in our atmosphere. Today, mainly through making fertiliser, nitrogen is flooding through our rivers, groundwater and continental shelves, fuelling algal blooms that lead to dead zones and fish kills.

 

And thirdly we are on the way to a very hot planet. Unless we change rapidly in the extremely near future, we risk an increase of 4 degrees Centigrade by 2100. So far, an increase of less than 1 degree is melting the West Antarctic icesheet, glaciers nearly everywhere and even the massive Greenland icecap.

 

Meanwhile, the rate of carbon dioxide and methane emissions continues to rise. In fact, right through the decade it took to write my book, I was staggered as these emissions defied all protocols and agreements, and rose faster and faster every year, setting a new record in 2013. Four degrees may be a bridge too far, and yet our culture is cheerfully crossing it.

 

I started out as a student of human history and ended up studying the intersection between human history and natural history. Humans have had local effects for thousands of years but on a global scale, the collision is new. Humans were a flea on the face of the earth for most of our history andit’s probably true to say this is the very first time one species—ours—has taken over the entire planetary system for its own sole use. In human-focused terms, this may seem perfectly reasonable. In planetary terms, it’s weird and completely impractical.

 

While our best agricultural land, last remnants of white box woodland and the Great Barrier Reef are put at risk for the extraction of gas and coal, which we should aim to stop burning anyway if we want a liveable world, it seems that only citizen revolt is left to counter it.

 

Let’s hope we succeed.

 

The ground of our being is at stake.

 

Robyn Williams: Kerryn Higgs. She’s with the University of Tasmania and her book, published by MIT Press, is called Collision Course – Endless Growth on a Finite Planet.Kerryn has recently been appointed a Fellow of the International Centre of the Club of Rome. Next week I shall introduce the proud Professor who’s just moved into that crumpled brown paper bag designed by Frank Gehry for the University of Technology, Sydney: Roy Green on innovation in Australia and what’s not right.

 

Guests

Dr Kerryn Higgs
Writer
University Associate
University of Tasmania
Fellow of the International Centre of the Club of Rome

Publications

Title
Collision Course – Endless Growth On A Finite Planet
Author
Kerryn Higgs
Publisher
MIT Press

Credits

Presenter
Robyn Williams
Producer
Brigitte Seega

Comments (3)

Add your comment


  • Peter Strachan :

    12 Feb 2015 6:57:48pm

    Thanks Kerryn for outlining the problem and much of its genesis. I find it interesting and frustrating that the obvious solution to our predicament is not mentioned.

    If we have a citizens revolt, and I believe that we will eventually come to that, what direction would this revolt take society? Call me old fashioned but I was rather hoping that human intellect could come to a better solution than amorphous revolt against the status quo.

    As we look around at existing resource constrained parts of our planet, there are already many visions of that citizens revolt already underway. In the Middle East, in North Africa, Rwanda, in eastern Europe and recently even on our doorstep in The Solomon Islands overpopulation, lack of water and unequal distribution of wealth has led to civil unrest and war, often cloaked in ethnic or religious garb to disguise its true cause.

    The solution is already in our hands and its called family planning or contraception if you like.

    It is clear that humanity will not be able to avert expansion of societal collapse which has already shown its early phase, while its population numbers keep rising by 80 million pa. Yet there is an unmet desire by women and men to plan and reduce fertility rates. Why are we not providing free choice to those who want this? Why do we continue to promote high birthrates?

    Within a decade, population growth rates could be significantly reduced and begin a necessary decline towards a more sustainable level.

    But who, apart from Kelvin Thompson is leading the charge? Perhaps more people should know of www.populationparty.org.au?

    Reply Alert moderator


  • Stephen S :

    14 Feb 2015 9:43:10am

    Gillard and Burke made sure that Labor’s 2011 ‘Sustainable Population Strategy’ contained little factual information and studiously avoided all these pressing questions.

    For another generation I fear, the opportunity was lost for a serious national debate about Australia’s rigid postwar policy of sustained high population growth.

    Reply Alert moderator


  • Michael Lardelli :

    14 Feb 2015 3:05:22pm

    An interesting talk Kerryn. As to the “why” of the current obsession with economic growth, the fault is in us. While, as individuals, we pretend to rationality, humans, as a group, do not act in this way. As the products of evolution by natural selection, we act to maximise reproduction – and pity the person who tries to argue against that! For males, greater wealth gives us more access to females. For females, greater wealth gives higher social status and more probable survival of children.

    The fact is that we NEED to believe in economic growth because, without that, we are forced to face up to the falsity of what I call “The Big Lie” – namely that we can all improve our lives / get rich. I wrote an essay on this a few years ago:

    http://www.onlineopinion.com.au/view.asp?article=13487&page=0

    When people are young they can be idealistic and believe that they can change the world. But that would require that the world be a rational place.

    When people are older and more cynical like me they realise that human irrationality is a surging tide against which nothing can stand. It will wash over the world and then retreat. All radically new biological innovations thrown up by Nature are like this. Just like a newly evolved microorganism sweeps through a host population wreaking destruction until it – and the host – evolve to commensality, so the new and incredibly adaptable human species will do the same, although how many thousands of years that will take is unknown.

    In the meantime, those of us who understand the inevitability of this process can find some small amount of solace by attempting to change things in our local community to enhance the survival of our own children, friends, neighbours and communities. At the local level, the rational part of one human can sometimes make a difference. And there is no sense in getting depressed about the inevitable.

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50% of US Healthcare Payments to be based on value by 2018

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/01/26/the-obama-administration-wants-to-dramatically-change-how-doctors-are-paid/

Wonkblog

The Obama administration wants to dramatically change how doctors are paid

By Jason Millman January 26
The Obama administration is setting aggressive goals for reforming how Medicare reimburses health-care providers. (AP Photo/Jeff Barnard)

The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.

Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018.

Monday’s announcement marks the administration’s biggest effort yet to shape how doctors are compensated across the health-care system. As the country’s largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor’s offices and hospitals across the country.

“As a very large payer in the system, we believe we have a responsibility to lead,” said Health and Human Services Secretary Sylvia Mathews Burwell in a press conference. “For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.”

There’s widespread agreement among policymakers that the U.S. health-care system needs to move away from rewarding doctors and hospitals for volume and focus more on the value of the care being offered. Doctors typically get paid set fees for every procedure they perform, regardless of whether patients get better.

In addition to improving patient care, the government also hopes to cut wasteful spending. Medicare’s current payment system, known as fee-for-service, cost taxpayers $362 billion last year, between the program’s hospital insurance and medical insurance programs, according to the federal Centers for Medicare and Medicaid Services. Critics say the traditional payment scheme fails to discourage overuse of health-care services, without holding providers accountable for whether patients’ get healthier.

Medicare has been experimenting with payment models for more than a decade, and the 2010 Affordable Care Act tried to tackle the issue by expanding payment models that reward providers for the value of care they provide. The programs include lump sum payments for treating a patient throughout an episode of care, like a knee replacement surgery.

The most high-profile effort has been with accountable care organizations (ACOs), which are groups of providers who share in the savings – or losses – for managing patients on a budget. An estimated 7.8 million seniors enrolled in Medicare are currently being served by ACOs, according to the administration.

Farzad Mostashari, a former Obama administration official whose company has helped launch and run three Medicare ACOs, said some hospitals have been reluctant to adopt these alternative payment models because believe they can make more money by charging for each service. But he said the administration’s announcement sends a clear signal that the health-care system is quickly moving away from a system that allows for so much waste.

CMS said alternative payment structures now represent about 20 percent of Medicare payments, and that will rise to 30 percent by 2016 under the administration’s new goals. This marks the first time that Medicare has set specific targets for expanding the scope of alternative payment systems in the program, CMS said.

Debra Ness, president of the National Partnership for Women and Families, a consumer advocacy organization, said these payment models will force health-care providers to better coordinate care.

“We’re not just talking about payment that lowers costs,” she said. “The payment changes are designed to change the way that we deliver care in ways that will make that care work better for patients and families.”

This shift to value-based payments had already been taking place in the private sector before the ACA. About 20 percent of provider payments by Blue Cross insurers are through contracts that try to prioritize quality over quantity, their trade association reported last summer. Aetna says 28 percent of its reimbursements are now in valued-based contracts, and it expects that rate to jump to 75 percent by 2020.

Many have viewed this broader shift as long overdue, as health care spending has grown to about one-sixth of the U.S. economy. But it’s still uncertain how well these payment approaches work.

“We still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program,” concluded a 2014 Rand Corporation study funded by HHS. The report, which reviewed pay-for-performance models implemented over the past decade, said improvements were “typically modest” and often hard to evaluate.

Some early efforts to implement newer value-based payment programs have shown mixed results.

Two high-profile ACA programs encouraging health-care providers to work as accountable care organizations have resulted in modest savings to the Medicare program so far, about $877 million. But at least 13 of the 32 organizations that participated in the most ambitious of these efforts — the Pioneer ACO program — have dropped out of the program in the past two years. Most of these groups left to join programs with less financial risk.

Farzad Mostashari, a former Obama administration official who now advises three Medicare ACOs, said some hospitals have been reluctant to adopt these alternative payment models because believe they could make more money by charging for each service. But he said the administration’s announcement sends a clear signal that the health-care system is quickly moving away from this wasteful payment scheme.

“It’s not so much about the specific goal, because that can and will change,” Mostashari said. “It’s about the sense of commitment that [hospitals] are perceiving.”

A representative for the American Hospital Association said the trade group supports the administration’s goals. Robert Wah, president of the American Medical Association, said members of the country’s largest doctor’s group were “encouraged” by Medicare’s efforts to reform how care is delivered, as they’ve become increasingly concerned by bureaucratic requirements.

“There is a great deal of regulatory and administrative burden on [doctors] currently,” Wah said. “We’re in a period of great change, and great change causes anxiety.”

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
cool, facts & data points, healthy habits, nutrition

What 200 Calories Look Like In Different Foods

What 200 Calories Look Like In Different Foods

940K views

719 days ago by Ieva

PDF: What 200 Calories Look Like in Different Foods _ Bored Panda
WiseGEEK conducted a very visual and informative study and presented a photo series, which compares what 200 calories actually look like in different foods. You’d think that even with the bikini season coming up, a handful of gummy bears couldn’t hurt much, right..? Well, turns out, just 51 gram of those gives you the same amount of calories as nearly 600 grams of broccoli or 3 whole eggs would. And now be honest – which of those amounts sounds more alike a proper and filling meal to you?[Read more…]

Apples (385 grams / 13.5 oz)

Butter (28 grams / 0.98 oz)

Broccoli (588 grams / 20.7 oz)

Snickers Chocolate Bar (41 grams / 1.45 oz)

Cooked Pasta (145 grams / 5.11 oz)

Hot Dogs (66 grams / 2.33 oz)

Kiwi Fruit (328 grams / 11.6 oz)

Jack in the Box Cheeseburger (75 grams / 2.6 oz)

Eggs (150 grams / 5.3 oz)

Celery (1425 grams / 50.3 oz)

Blackberry Pie (56 grams / 1.97 oz)

Mini Peppers (740 grams / 26.1 oz)

Canned Black Beans (186 grams / 6.56 oz)

Werther’s Originals Candy (50 grams / 1.76 oz)

Jack in the Box Chicken Sandwich (72 grams / 2.5 oz)

Glazed Doughnut (52 grams / 1.8 oz)

French Sandwich Roll (72 grams / 2.5 oz)

Avocado (125 grams / 4.4 oz)

Canned Sweet Corn (308 grams / 10.9 oz)

Baby Carrots (570 gram / 20.1 oz)

Canned Green Peas (357 grams / 12.6 oz)

Canned Pork and Beans (186 grams / 6.56 oz)

Doritos (41 grams / 1.44 oz)

Dried Apricots (83 grams / 2.9 oz)

Jack in the Box French Fries (73 grams / 2.6 oz)

Fried Bacon (34 grams / 1.2 oz)

Fruit Loops Cereal (51 grams / 1.8 oz)

Grapes (290 grams / 10.2 oz)

Splenda Artifical Sweetener (50 grams / 1.8 oz)

Gummy Bears (51 grams / 1.8 oz)

Hershey Kisses (36 grams / 1.27 oz)

Honeydew Melon (553 grams / 19.5 oz)

Jelly Belly Jelly Beans (54 grams / 1.9 oz)

Ketchup (226 grams / 7.97 oz)

M&M Candy (40 grams / 1.4 oz)

Red Onions (475 grams / 16.75 oz)

Sliced Smoked Turkey (204 grams / 7.2 oz)

Coca Cola (496 ml / 16.77 oz)

Canola Oil (23 grams / 0.8 oz)

Smarties Candy (57 grams / 2 oz)

Tootsie Pops (68 grams / 2.4 oz)

Whole Milk (333 ml / 11.3 fl oz)

Balsamic Vinegar (200 ml / 6.8 fl oz)

Lowfat Strawberry Yogurt (196 grams / 6.9 oz)

Canned Chili con Carne (189 grams / 6.7 oz)

Canned Tuna Packed in Oil (102 grams / 3.6 oz)

Fiber One Cereal (100 grams / 3.5 oz)

Flax Bread (90 grams / 3.17 oz)

Blueberry Muffin (72 grams / 2.5 oz)

Bailey’s Irish Cream (60 ml / 2.02 fl oz)

Cranberry Vanilla Crunch Cereal (55 grams / 1.9 oz)

Cornmeal (55 grams / 1.94 oz)

Wheat Flour (55 grams / 1.94 oz)

Peanut Butter Power Bar (54 grams / 1.9 oz)

Puffed Rice Cereal (54 grams / 1.9 oz)

Puffed Wheat Cereal (53 grams / 1.87 oz)

Brown Sugar (53 grams / 1.87 oz)

Salted Pretzels (52 grams / 1.83 oz)

Medium Cheddar Cheese (51 grams / 1.8 oz)

Potato Chips (37 grams / 1.3oz)

Sliced and Toasted Almonds (35 grams / 1.23 oz)

Peanut Butter (34 grams / 1.2 oz)

Salted Mixed Nuts (33 grams / 1.16 oz)

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RWJF continues to go large on childhood obesity

 

 

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2015/02/rwjf_doubles_commitment_to_healthy_weight_for_children.html

Robert Wood Johnson Foundation Doubles Its Commitment to Helping All Children Grow Up at a Healthy Weight

RWJF dedicates a total of $1 billion since 2007 to ensuring that all children have access to healthier foods and opportunities to be physically active.

February 5, 2015

Princeton, N.J.―Recognizing that obesity remains one of the biggest threats to the health of our children, the Robert Wood Johnson Foundation (RWJF) today announced it will commit $500 million over the next ten years to expand efforts to ensure that all children in the United States—no matter who they are or where they live―can grow up at a healthy weight. Building on a $500 million commitment made in 2007, the nation’s largest health philanthropy will have dedicated more than $1 billion to reversing the childhood obesity epidemic. Encouraged by recent signs of progress in turning rates around, RWJF views this investment as critical to building a Culture of Health in communities across the United States.

With this new $500 million pledge, RWJF signals its commitment to expand and accelerate that progress, with an intensified focus on those places and populations hardest hit by the epidemic. New work will advance strategies that help eliminate health disparities that contribute to higher obesity rates among children of color and children living in poverty across the United States. The Foundation also announced an expanded focus on preventing obesity in early childhood and on engaging parents, youth and health care providers to be active champions for healthier communities and schools.

Over the last decade, RWJF has been a leader in supporting nationwide efforts to change policies and school and community environments in ways that make the healthy choice the easy choice for children and families. Working in partnership with other funders and leaders in a variety of sectors, key initiatives enabled schools nationwide to transform their campuses into healthier places for kids and helped communities expand access to nutritious foods and safe places to be active. States and cities ranging from California to Mississippi, and New York City to Anchorage, Alaska, have begun reporting declining childhood obesity rates.

“By 2025, we want to ensure that children in America grow up at a healthy weight, no matter who they are or where they live,” said RWJF President and CEO Risa Lavizzo-Mourey, MD. “We have made substantial progress, but there is far more to do and we can’t stop now. This commitment is part of the Foundation’s effort to build a Culture of Health in every community across the country. We all have a role to play in our homes, schools, and neighborhoods to ensure that all kids have healthy food and safe places to play.”

Building on work the Foundation has implemented previously, RWJF will support research, action and advocacy strategies focused on the following priorities over the next decade:

  • Ensure that all children enter kindergarten at a healthy weight.
  • Make a healthy school environment the norm and not the exception across the United States.
  • Make physical activity a part of the everyday experience for children and youth.
  • Make healthy foods and beverages the affordable, available, and desired choice in all neighborhoods and communities.
  • Eliminate the consumption of sugar-sweetened beverages among 0-5 year olds.

This new $500 million commitment represents a major investment in the Foundation’s broader effort to build a nationwide Culture of Health that enables all in our diverse society to lead healthier lives, now and for generations to come. Integral to building a strong Culture of Health is helping all children achieve and maintain a healthy weight to give them the strongest start toward a healthy future. This will require greater collaboration among businesses, government, individuals, and organizations to create communities that offer ample opportunities for parents and kids to make choices that help them live the healthiest lives possible.

RWJF’s new commitment follows a series of research reports showing progress toward reversing the childhood obesity epidemic. On a national level, childhood obesity rates have begun to level off, according to the Centers for Disease Control and Prevention (CDC). The CDC also released data last year showing rates may be decreasing among the nation’s youngest children. In addition, states from California to Mississippi and cities from Anchorage to Philadelphia have reported reductions in childhood obesity rates.

But these initial reports of declines follow decades of increases. Despite the recent positive news, more than one third of young people are overweight or obese—a rate far higher than it was a generation ago. African-American and Latino youth continue to have higher obesity rates than their white peers, even in most areas reporting overall progress. Among the cities and states reporting good news on obesity, only Philadelphia has measured progress toward narrowing disparity gaps. In that city, childhood obesity rates have declined overall, and the steepest drops have been among African-American boys and Latino girls, two groups with historically high obesity rates.

“The Robert Wood Johnson Foundation is in this fight for the long haul to ensure that all kids grow up at a healthy weight,” said Roger S. Fine, JD, chairman of the RWJF Board of Trustees. “With this new commitment, we look forward to working with existing and new allies to realize a future in which every child can live a long, healthy life.”

Since its 2007 commitment, RWJF has funded numerous efforts to help young people eat healthier foods and be more active. It helped the Healthy Schools Program of the Alliance for a Healthier Generation grow from supporting 231 schools in 2006 to now more than 26,000 schools that are transforming their campuses into healthier places where healthy foods and physical activity are available before, during and after school. It created Healthy Kids, Healthy Communities, a national program supporting community change efforts that made healthy eating and active living the easy choice in 50 sites across the country and served as a model for later federal funding. The Foundation also has funded independent evaluations of significant commitments by the food and beverage industry, which demonstrated progress by major companies to cut 6.4 trillion calories from the marketplace.

In addition to work by RWJF and its grantees, the last several years have seen a building national movement to address childhood obesity. First Lady Michelle Obama has made a significant commitment to solving the challenge of childhood obesity through her Let’s Move! initiative. Congress passed the Healthy, Hunger-Free Kids Act with a bipartisan vote in 2010, paving the way for the first significant update to school nutrition standards in 15 years and laying the groundwork for broader policy changes. Food, beverage, and fitness industry leaders, as well as many others, have made changes to their products and practices in order to better support children’s health. As progress continues and expands, sustained action across sectors will be essential to creating a healthier future for children.

ABOUT THE ROBERT WOOD JOHNSON FOUNDATION

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

http://www.rwjf.org/en/blogs/culture-of-health/2015/02/we_must_all_playar.html

We Must All Play a Role in Ending Childhood Obesity

Feb 5, 2015, 1:00 PM, Posted by Sen. Bill Frist, MD

A mother walking with her daughters on sidewalk
We all want our kids and grandkids to grow up happier and healthier than we did. Instead, today’s children are the first generation of young Americans to face the prospect of living their entire lives in poorer health and dying younger than previous generations.The reason is no mystery. Too many of our children – one in three, according to studies – are overweight. We are allowing, and in some ways encouraging, our kids to consume more calories, more sugar, more fat, more sodium. At the same time we’re enabling a more sedentary lifestyle. Running, jumping, skipping, dancing, biking – today’s children simply don’t move as much as they once did, making it that much harder to keep off the pounds.The childhood obesity epidemic is having a devastating affect on too many families. Obese and overweight children are sick more often. They too often endure prejudice and bullying at school, leaving them embarrassed and depressed. They miss more school. When they grow up, they have more difficulty leading productive work lives. And they are more likely to suffer from chronic illnesses directly linked to obesity, such as diabetes and heart disease.

William FristSen. Bill Frist, MD
All of society pays a stiff price for childhood obesity. Twenty percent of the United States’ total expenditures on health care can be linked to conditions associated with obesity. Obesity costs our society more than smoking or drinking.But there is reason for hope. Parents, educators, business leaders, government officials, health care professionals, and nonprofits have launched remarkable initiatives to end this epidemic. The Robert Wood Johnson Foundation has been a leader in these efforts, ever since its dramatic $500 million initiative in 2007 to reverse trends in childhood obesity. And there are signs that we are already creating a brighter future for our children.In the last two years the Centers for Disease Control and Prevention (CDC) have reported small but significant downward trends in the percentage of preschool-aged children who are obese. Those kids are less likely to be obese when they are in middle school, high school, and beyond.

How did we begin to alter a movement that once seemed impossible to stop? I like to think of it as a good old-fashioned American mix of families, educators, policy makers and businesses pulling together to bring about change. Parents are getting out and doing things with their kids – hiking, jogging, cycling, swimming, throwing a ball or Frisbee around – and both parents and kids find themselves feeling better. Schools are offering healthy lunch choices, and making good food, including breakfast, available for students who might otherwise be able to afford only junk food, or no food at all. Cities and states are requiring fast-food outlets to post nutrition information. Large retail chains are building fresh-food grocery stores that represent oases of healthy nutrition in “food deserts.” Hospitals and clinics are emphasizing preventive care programs. Foundations such as RWJF, with its efforts to build a Culture of Health, are promoting innovative pilot programs and partnerships. All these efforts, taken together, are truly making a difference.

But there’s no question that we have a long way to go. We can all do more, and we must do more, both individually, through our organizations, and in partnership with others. That’s why RWJF is pledging another $500 million over the next ten years to expand efforts to ensure that all children in the United States―no matter who they are or where they live―can grow up at a healthy weight.

What can you do? Take a kid bowling, or for a hike. Suggest alternatives to fried foods at the next covered-dish supper held at your church. Write your elected representatives expressing your support for programs to fight childhood obesity. Present a petition to the school board asking that physical education be reinstated or expanded, and that unhealthy snacks and drinks be removed. Ask the city council to ensure that all kids and families have access to safe parks and playgrounds. Donate money or volunteer your time to programs fighting childhood obesity. Buy and serve healthy foods for yourself and your family, and do your best to let everyone in the food chain know – from the local grocery manager to the big brand-name food companies to the farmer at the local greenmarket – that you want healthy, fresh food.

It’s been shown time and again, all across the country: If we make healthy food and exercise options easy and affordable, those are the choices that most families will make for their children. Please do your part to help America’s kids. Here at the Foundation, we’ll be supporting you all the way.

Bill Frist, a heart surgeon, is a former U. S. senator (R-Tenn) who has long been involved in promoting good health across America. He is a member of the Board of Trustees of the Robert Wood Johnson Foundation.

Working in partnership with other funders and leaders in a variety of sectors, key initiatives enabled schools nationwide to transform their campuses into healthier places for kids and helped communities expand access to nutritious foods and safe places to be active. States and cities ranging from California to Mississippi, and New York City to Anchorage, Alaska, have begun reporting declining childhood obesity rates

EF, health market quality, healthcare, policy, rapid learning health systems

Private Players Launch Value-based Task Force

 

http://www.healthleadersmedia.com/print/HEP-312643/Private-Players-Launch-Valuebased-Task-Force

Private Players Launch Value-based Task Force

John Commins, for HealthLeaders Media , January 29, 2015

Two days after HHS unveiled significant Medicare payment reforms, a group of commercial payers, providers, and industry partners says it is committed to putting 75% of its business into value-based models by 2020.

Some of the nation’s largest healthcare systems and payers on Wednesday launched theHealth Care Transformation Task Force, with an ambitious commitment to put 75% of their business into value-based models by 2020.

Steven Brill

Richard J. Gilfillan, MD
CEO of Trinity Health

The task force describes itself as a “private sector alliance dedicated to accelerating the transformation of the U.S. health care system to value-based business and clinical models aligned with improving outcomes and lowering costs.”   Members include commercial payers, providers, and partners.

The announcement comes just two days after Health and Human Services Secretary Sylvia Burwell announced plans to ramp up Medicare payment reforms featuring alternative payment models and value-based payments.

Richard J. Gilfillan, MD, CEO of Livonia, MI-based Trinity Health, is chairman of the task force, which he said is “committed to rapid, measurable change both for ourselves and our country that will improve quality and make healthcare more accessible for all American families.”

Gilfillan spoke with HealthLeaders Media on Wednesday about the task force and the goals and challenges it will face in the coming months and years. The following is an edited transcript.

HealthLeaders Media: What is your biggest concern about the value-based care rollout and how can your task force prevent it from happening?

Richard Gilfillan: My biggest concern is that as an organization we don’t get there in a timely way because we find ourselves having to respond to the pushes and pulls from all directions as opposed to a clear and smooth path forward.

My concern from the broader perspective of the industry is that this is an incredible time and a great opportunity to get to where we all want to get to. I’d hate for us to miss the opportunity because we can’t find a way to make it happen, and this kind of cooperation in setting goals and working together really gives us an optimal chance to transform our care system.

HLM: Are you concerned that the value-based rollout could become as disorganized as the HIT rollout?

RG: I wouldn’t want to come off as being critical of that specific issue and segment of the industry. From a provider standpoint I am concerned, and I used to be in the payer business as well. I know that we all—whether providers, payers, or employers, or advocates for patients—have our ideas and we think they are the best and only way.

This is hard work for providers and payers making this big transition. If we are pushing and pulling on 10 different paths to how we see it and what we think the timing should be, it’s even harder.

People will find themselves in this hedging scenario, one foot in the canoe and one on the dock. If we could get some commonality around time frame and consistency of approach then it is very doable.

HLM: Are you on the same page as HHS at this point on the value-based rollout?

RG: Secretary Burwell talked about two sets of metrics. One was for gauging the extent to which their payments are operating under these alternative contracts, which they defined as medical homes with triple-aim outcomes, bundled payment programs, ACO programs. That aligns directly with our thinking about our 75% commitment.

They also talked about how many of the dollars would be operating under the value-based payment systems, which is more the incentive-type arrangements that don’t necessarily have total cost of care included.

I understand that they needed to pay attention to that space. We are well-aligned in terms of the goals and the definitions. Hopefully, we’ll find that as the industry comes together to develop the best ways to get at that and define those models in more detail, that is where we will influence each other and come to an approach that works.

We would like to work with HHS and CMS to do the most we can to create a synergistic approach. There is a lot of potential for building momentum in the private sector as well.

HLM: Why do you believe this transition should be “rapid?”

RG: We have found as we have talked to other providers that it’s really hard to operate in two or three different ways. At first everyone said, ‘let me try a little alternative contracting, a little responsibility for total cost of care and better outcomes, but I want to keep my old way of doing things too.’

People realized that the halfway world is very difficult and disorienting for an organization and its people. That period of uncertainty, mixed messages, and confusion, is painful. Many of us have said, ‘let’s find our way to that sooner and be on a specific path so we can communicate in a straightforward way with our organization and people.’

We want to give them a clear message and a path forward and a sense of where we are going so that we can plan that out and execute on it in a logical thoughtful way. Most of us feel that it’s better to do it sooner rather than drag it out into an extended period of uncertainty.

HLM: So the mindset now is that this is going to happen so we might as well get it done?

RG: I think so. The other thing we are realizing is that it’s not just about cost, or quality, or health. It’s about all three. Nobody went into healthcare to deliver fragmented, uncoordinated, inaccessible, and unaffordable care. This is actually taking us back to why we went into healthcare. It’s exciting. Let’s get there sooner rather than later. The country needs this sooner rather than later from a lot of perspectives.

HLM: Did the timing of the HHS announcement on Monday affect your announcement?

RG: Our first meeting was in June and we were reaching out to people two or three months before that. This is almost a year’s work getting to this point. People in Washington have talked about there being a timeline from the federal government since 2009.

We heard from the secretary’s office a week and a half ago that there was going to be some announcement. They were putting a stake in the sand. We were invited to be part of an initial information session and then we were invited to join the secretary at the announcement.

We realized this is very much on a parallel track and one that works. It’s a great coming together of people’s thinking about what it would take to be successful.

HLM: Do you anticipate more disagreements within the task force as you address more specific details on how value-based care will work?

RG: The answer is yes. We do anticipate differences of perspective. The reason we need to do this is because there are multiple perspectives and those perspectives are different among providers and payers and across those groups.

We have already done some hard work in talking through those differences and creating what we think is a preferred set of principles and policies.

Our most immediate effort is going to be to provide comments in the episode-based payment space and in ACOs and we are working on that now. So yes, there will be differences, but that is the purpose of this.

We have to listen to each other and understand each other’s perspectives and this task force creates a context in which we can actually do that. We hope we can provide input for CMS along the way.

HLM: How did you come to decide upon 75% in value-based by 2020?  

RG: We knew that one of the key goals here was to put a stake in the ground that we all had to agree to and 75% and five years seemed reasonable.

HLM: How will the task force spend its time over the next few months?

RG: Organizationally, we just launched publically and we are still putting the logistics in place to operate the task force. It’s been up and operating, but we are trying to understand the best way to engage as many people and organizations as possible, so we are working through the best way to do that, and respond to what we see as a lot of interest.

There are a lot of people who are interested and I hope between this and the HHS announcement people will see it’s a good time to make that commitment organizationally.

HLM: Do you expect the task force to take on new members in the coming years?

RG: This is about folks coming together who hope and expect that others will be interested in signing on and working on this goal. I am already getting a fair number of inquiries from folks saying they’d like to be involved.

business, complex adaptive systems, cool, data saving lives, EF, entrepreneurship, file note, health market quality, healthcare, healthy habits, meaning, musings, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology, startup, storytelling, technology

Establishing markets in prevention and wellness – 3 examples

1. AIA Vitality Life Insurance

  • https://www.aiavitality.com.au/vmp-au/
  • Wendy Brown – University of Queensland wbrown@hms.uq.edu.au
  • Tracy Kolbe-Alexander – University of Queensland

2. Data Driven Healthcare Quality Markets

3. Abu Dhabi Health Authority – Weqaya

 

 

Vitality Institute Commission – Recommendation 3 http://thevitalityinstitute.org/commission/create-markets-for-health/

data saving lives, research methodology

FT: Big data: are we making a big mistake?

A very good article on the ins and outs of big data.

http://www.ft.com/intl/cms/s/2/21a6e7d8-b479-11e3-a09a-00144feabdc0.html#axzz3AVZ1Wv00

March 28, 2014 11:38 am

Big data: are we making a big mistake?

By Tim Harford

Big data is a vague term for a massive phenomenon that has rapidly become an obsession with entrepreneurs, scientists, governments and the media
Illustration by Ed Nacional depicting big data©Ed Nacional

F

ive years ago, a team of researchers from Google announced a remarkable achievement in one of the world’s top scientific journals, Nature. Without needing the results of a single medical check-up, they were nevertheless able to track the spread of influenza across the US. What’s more, they could do it more quickly than the Centers for Disease Control and Prevention (CDC). Google’s tracking had only a day’s delay, compared with the week or more it took for the CDC to assemble a picture based on reports from doctors’ surgeries. Google was faster because it was tracking the outbreak by finding a correlation between what people searched for online and whether they had flu symptoms.

Not only was “Google Flu Trends” quick, accurate and cheap, it was theory-free. Google’s engineers didn’t bother to develop a hypothesis about what search terms – “flu symptoms” or “pharmacies near me” – might be correlated with the spread of the disease itself. The Google team just took their top 50 million search terms and let the algorithms do the work.

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The success of Google Flu Trends became emblematic of the hot new trend in business, technology and science: “Big Data”. What, excited journalists asked, can science learn from Google?

As with so many buzzwords, “big data” is a vague term, often thrown around by people with something to sell. Some emphasise the sheer scale of the data sets that now exist – the Large Hadron Collider’s computers, for example, store 15 petabytes a year of data, equivalent to about 15,000 years’ worth of your favourite music.

But the “big data” that interests many companies is what we might call “found data”, the digital exhaust of web searches, credit card payments and mobiles pinging the nearest phone mast. Google Flu Trends was built on found data and it’s this sort of data that ­interests me here. Such data sets can be even bigger than the LHC data – Facebook’s is – but just as noteworthy is the fact that they are cheap to collect relative to their size, they are a messy collage of datapoints collected for disparate purposes and they can be updated in real time. As our communication, leisure and commerce have moved to the internet and the internet has moved into our phones, our cars and even our glasses, life can be recorded and quantified in a way that would have been hard to imagine just a decade ago.

Cheerleaders for big data have made four exciting claims, each one reflected in the success of Google Flu Trends: that data analysis produces uncannily accurate results; that every single data point can be captured, making old statistical sampling techniques obsolete; that it is passé to fret about what causes what, because statistical correlation tells us what we need to know; and that scientific or statistical models aren’t needed because, to quote “The End of Theory”, a provocative essay published in Wired in 2008, “with enough data, the numbers speak for themselves”.

Illustration by Ed Nacional depicting big data©Ed Nacional

Unfortunately, these four articles of faith are at best optimistic oversimplifications. At worst, according to David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Cambridge university, they can be “complete bollocks. Absolute nonsense.”

Found data underpin the new internet economy as companies such as Google, Facebook and Amazon seek new ways to understand our lives through our data exhaust. Since Edward Snowden’s leaks about the scale and scope of US electronic surveillance it has become apparent that security services are just as fascinated with what they might learn from our data exhaust, too.

Consultants urge the data-naive to wise up to the potential of big data. A recent report from the McKinsey Global Institute reckoned that the US healthcare system could save $300bn a year – $1,000 per American – through better integration and analysis of the data produced by everything from clinical trials to health insurance transactions to smart running shoes.

But while big data promise much to scientists, entrepreneurs and governments, they are doomed to disappoint us if we ignore some very familiar statistical lessons.

“There are a lot of small data problems that occur in big data,” says Spiegelhalter. “They don’t disappear because you’ve got lots of the stuff. They get worse.”

. . .

Four years after the original Nature paper was published, Nature News had sad tidings to convey: the latest flu outbreak had claimed an unexpected victim: Google Flu Trends. After reliably providing a swift and accurate account of flu outbreaks for several winters, the theory-free, data-rich model had lost its nose for where flu was going. Google’s model pointed to a severe outbreak but when the slow-and-steady data from the CDC arrived, they showed that Google’s estimates of the spread of flu-like illnesses were overstated by almost a factor of two.

The problem was that Google did not know – could not begin to know – what linked the search terms with the spread of flu. Google’s engineers weren’t trying to figure out what caused what. They were merely finding statistical patterns in the data. They cared about ­correlation rather than causation. This is common in big data analysis. Figuring out what causes what is hard (impossible, some say). Figuring out what is correlated with what is much cheaper and easier. That is why, according to Viktor Mayer-Schönberger and Kenneth Cukier’s book, Big Data, “causality won’t be discarded, but it is being knocked off its pedestal as the primary fountain of meaning”.

But a theory-free analysis of mere correlations is inevitably fragile. If you have no idea what is behind a correlation, you have no idea what might cause that correlation to break down. One explanation of the Flu Trends failure is that the news was full of scary stories about flu in December 2012 and that these stories provoked internet searches by people who were healthy. Another possible explanation is that Google’s own search algorithm moved the goalposts when it began automatically suggesting diagnoses when people entered medical symptoms.

Illustration by Ed Nacional depicting big data©Ed Nacional

Google Flu Trends will bounce back, recalibrated with fresh data – and rightly so. There are many reasons to be excited about the broader opportunities offered to us by the ease with which we can gather and analyse vast data sets. But unless we learn the lessons of this episode, we will find ourselves repeating it.

Statisticians have spent the past 200 years figuring out what traps lie in wait when we try to understand the world through data. The data are bigger, faster and cheaper these days – but we must not pretend that the traps have all been made safe. They have not.

. . .

In 1936, the Republican Alfred Landon stood for election against President Franklin Delano Roosevelt. The respected magazine, The Literary Digest, shouldered the responsibility of forecasting the result. It conducted a postal opinion poll of astonishing ambition, with the aim of reaching 10 million people, a quarter of the electorate. The deluge of mailed-in replies can hardly be imagined but the Digest seemed to be relishing the scale of the task. In late August it reported, “Next week, the first answers from these ten million will begin the incoming tide of marked ballots, to be triple-checked, verified, five-times cross-classified and totalled.”

After tabulating an astonishing 2.4 million returns as they flowed in over two months, The Literary Digest announced its conclusions: Landon would win by a convincing 55 per cent to 41 per cent, with a few voters favouring a third candidate.

The election delivered a very different result: Roosevelt crushed Landon by 61 per cent to 37 per cent. To add to The Literary Digest’s agony, a far smaller survey conducted by the opinion poll pioneer George Gallup came much closer to the final vote, forecasting a comfortable victory for Roosevelt. Mr Gallup understood something that The Literary Digest did not. When it comes to data, size isn’t everything.

Opinion polls are based on samples of the voting population at large. This means that opinion pollsters need to deal with two issues: sample error and sample bias.

Sample error reflects the risk that, purely by chance, a randomly chosen sample of opinions does not reflect the true views of the population. The “margin of error” reported in opinion polls reflects this risk and the larger the sample, the smaller the margin of error. A thousand interviews is a large enough sample for many purposes and Mr Gallup is reported to have conducted 3,000 interviews.

But if 3,000 interviews were good, why weren’t 2.4 million far better? The answer is that sampling error has a far more dangerous friend: sampling bias. Sampling error is when a randomly chosen sample doesn’t reflect the underlying population purely by chance; sampling bias is when the sample isn’t randomly chosen at all. George Gallup took pains to find an unbiased sample because he knew that was far more important than finding a big one.

The Literary Digest, in its quest for a bigger data set, fumbled the question of a biased sample. It mailed out forms to people on a list it had compiled from automobile registrations and telephone directories – a sample that, at least in 1936, was disproportionately prosperous. To compound the problem, Landon supporters turned out to be more likely to mail back their answers. The combination of those two biases was enough to doom The Literary Digest’s poll. For each person George Gallup’s pollsters interviewed, The Literary Digest received 800 responses. All that gave them for their pains was a very precise estimate of the wrong answer.

The big data craze threatens to be The Literary Digest all over again. Because found data sets are so messy, it can be hard to figure out what biases lurk inside them – and because they are so large, some analysts seem to have decided the sampling problem isn’t worth worrying about. It is.

Professor Viktor Mayer-Schönberger of Oxford’s Internet Institute, co-author of Big Data, told me that his favoured definition of a big data set is one where “N = All” – where we no longer have to sample, but we have the entire background population. Returning officers do not estimate an election result with a representative tally: they count the votes – all the votes. And when “N = All” there is indeed no issue of sampling bias because the sample includes everyone.

But is “N = All” really a good description of most of the found data sets we are considering? Probably not. “I would challenge the notion that one could ever have all the data,” says Patrick Wolfe, a computer scientist and professor of statistics at University College London.

An example is Twitter. It is in principle possible to record and analyse every message on Twitter and use it to draw conclusions about the public mood. (In practice, most researchers use a subset of that vast “fire hose” of data.) But while we can look at all the tweets, Twitter users are not representative of the population as a whole. (According to the Pew Research Internet Project, in 2013, US-based Twitter users were disproportionately young, urban or suburban, and black.)

There must always be a question about who and what is missing, especially with a messy pile of found data. Kaiser Fung, a data analyst and author of Numbersense, warns against simply assuming we have everything that matters. “N = All is often an assumption rather than a fact about the data,” he says.

Consider Boston’s Street Bump smartphone app, which uses a phone’s accelerometer to detect potholes without the need for city workers to patrol the streets. As citizens of Boston download the app and drive around, their phones automatically notify City Hall of the need to repair the road surface. Solving the technical challenges involved has produced, rather beautifully, an informative data exhaust that addresses a problem in a way that would have been inconceivable a few years ago. The City of Boston proudly proclaims that the “data provides the City with real-time in­formation it uses to fix problems and plan long term investments.”

Yet what Street Bump really produces, left to its own devices, is a map of potholes that systematically favours young, affluent areas where more people own smartphones. Street Bump offers us “N = All” in the sense that every bump from every enabled phone can be recorded. That is not the same thing as recording every pothole. As Microsoft researcher Kate Crawford points out, found data contain systematic biases and it takes careful thought to spot and correct for those biases. Big data sets can seem comprehensive but the “N = All” is often a seductive illusion.

. . .

Who cares about causation or sampling bias, though, when there is money to be made? Corporations around the world must be salivating as they contemplate the uncanny success of the US discount department store Target, as famously reported by Charles Duhigg in The New York Times in 2012. Duhigg explained that Target has collected so much data on its customers, and is so skilled at analysing that data, that its insight into consumers can seem like magic.

Duhigg’s killer anecdote was of the man who stormed into a Target near Minneapolis and complained to the manager that the company was sending coupons for baby clothes and maternity wear to his teenage daughter. The manager apologised profusely and later called to apologise again – only to be told that the teenager was indeed pregnant. Her father hadn’t realised. Target, after analysing her purchases of unscented wipes and magnesium supplements, had.

Statistical sorcery? There is a more mundane explanation.

“There’s a huge false positive issue,” says Kaiser Fung, who has spent years developing similar approaches for retailers and advertisers. What Fung means is that we didn’t get to hear the countless stories about all the women who received coupons for babywear but who weren’t pregnant.

Illustration by Ed Nacional depicting big data©Ed Nacional

Hearing the anecdote, it’s easy to assume that Target’s algorithms are infallible – that everybody receiving coupons for onesies and wet wipes is pregnant. This is vanishingly unlikely. Indeed, it could be that pregnant women receive such offers merely because everybody on Target’s mailing list receives such offers. We should not buy the idea that Target employs mind-readers before considering how many misses attend each hit.

In Charles Duhigg’s account, Target mixes in random offers, such as coupons for wine glasses, because pregnant customers would feel spooked if they realised how intimately the company’s computers understood them.

Fung has another explanation: Target mixes up its offers not because it would be weird to send an all-baby coupon-book to a woman who was pregnant but because the company knows that many of those coupon books will be sent to women who aren’t pregnant after all.

None of this suggests that such data analysis is worthless: it may be highly profitable. Even a modest increase in the accuracy of targeted special offers would be a prize worth winning. But profitability should not be conflated with omniscience.

. . .

In 2005, John Ioannidis, an epidemiologist, published a research paper with the self-explanatory title, “Why Most Published Research Findings Are False”. The paper became famous as a provocative diagnosis of a serious issue. One of the key ideas behind Ioannidis’s work is what statisticians call the “multiple-comparisons problem”.

It is routine, when examining a pattern in data, to ask whether such a pattern might have emerged by chance. If it is unlikely that the observed pattern could have emerged at random, we call that pattern “statistically significant”.

The multiple-comparisons problem arises when a researcher looks at many possible patterns. Consider a randomised trial in which vitamins are given to some primary schoolchildren and placebos are given to others. Do the vitamins work? That all depends on what we mean by “work”. The researchers could look at the children’s height, weight, prevalence of tooth decay, classroom behaviour, test scores, even (after waiting) prison record or earnings at the age of 25. Then there are combinations to check: do the vitamins have an effect on the poorer kids, the richer kids, the boys, the girls? Test enough different correlations and fluke results will drown out the real discoveries.

There are various ways to deal with this but the problem is more serious in large data sets, because there are vastly more possible comparisons than there are data points to compare. Without careful analysis, the ratio of genuine patterns to spurious patterns – of signal to noise – quickly tends to zero.

Worse still, one of the antidotes to the ­multiple-comparisons problem is transparency, allowing other researchers to figure out how many hypotheses were tested and how many contrary results are languishing in desk drawers because they just didn’t seem interesting enough to publish. Yet found data sets are rarely transparent. Amazon and Google, Facebook and Twitter, Target and Tesco – these companies aren’t about to share their data with you or anyone else.

New, large, cheap data sets and powerful ­analytical tools will pay dividends – nobody doubts that. And there are a few cases in which analysis of very large data sets has worked miracles. David Spiegelhalter of Cambridge points to Google Translate, which operates by statistically analysing hundreds of millions of documents that have been translated by humans and looking for patterns it can copy. This is an example of what computer scientists call “machine learning”, and it can deliver astonishing results with no preprogrammed grammatical rules. Google Translate is as close to theory-free, data-driven algorithmic black box as we have – and it is, says Spiegelhalter, “an amazing achievement”. That achievement is built on the clever processing of enormous data sets.

But big data do not solve the problem that has obsessed statisticians and scientists for centuries: the problem of insight, of inferring what is going on, and figuring out how we might intervene to change a system for the better.

“We have a new resource here,” says Professor David Hand of Imperial College London. “But nobody wants ‘data’. What they want are the answers.”

To use big data to produce such answers will require large strides in statistical methods.

“It’s the wild west right now,” says Patrick Wolfe of UCL. “People who are clever and driven will twist and turn and use every tool to get sense out of these data sets, and that’s cool. But we’re flying a little bit blind at the moment.”

Statisticians are scrambling to develop new methods to seize the opportunity of big data. Such new methods are essential but they will work by building on the old statistical lessons, not by ignoring them.

Recall big data’s four articles of faith. Uncanny accuracy is easy to overrate if we simply ignore false positives, as with Target’s pregnancy predictor. The claim that causation has been “knocked off its pedestal” is fine if we are making predictions in a stable environment but not if the world is changing (as with Flu Trends) or if we ourselves hope to change it. The promise that “N = All”, and therefore that sampling bias does not matter, is simply not true in most cases that count. As for the idea that “with enough data, the numbers speak for themselves” – that seems hopelessly naive in data sets where spurious patterns vastly outnumber genuine discoveries.

“Big data” has arrived, but big insights have not. The challenge now is to solve new problems and gain new answers – without making the same old statistical mistakes on a grander scale than ever.

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Tim Harford’s latest book is ‘The Undercover Economist Strikes Back’. To comment on this article please post below, or email magazineletters@ft.com

 

EF, health market quality, healthcare, nutrition, policy

HBR Blog: Preventive Health Care Markets

 

https://hbr.org/2014/11/what-the-u-s-can-learn-from-india-and-brazil-about-preventive-health-care

What the U.S. Can Learn From India and Brazil About Preventive Health Care

NOVEMBER 14, 2014

media companies, automakers, clothing retailers, and other industries have for decades looked abroad to find ideas and innovations they can adapt for the US market. But in one of America’s largest, fastest growing, and sometimes most confounding sectors — healthcare — the situation is different.

Imports like aspirin (Germany) and the heart transplant (South Africa) have become almost as American as apple pie. But in preventive health — keeping people from getting sick, or helping them manage the conditions they do have — we adapt too few of the best foreign innovations and models that have proven to be effective and sustainable at scale.

The U.S. spends far more per capita on healthcare than any other nation. Clearly we need to adopt cost-effective prevention efforts where we can. And we have to do so in a way that fits our health care infrastructure, including reliance on the private sector — a mix of for-profit and non-profit payers and providers — as the bedrock of our system. Two tactics that do fit, and can both lower costs and improve patient care, include more expansive use of mobile technology and of lay health workers. Both can be supported by non-profit intermediaries. Scalable models for these interventions are in use and successful in emerging economies, and are particularly germane where it comes to preventing illness and disease in low-income or geographically or linguistically hard-to-reach patient populations.

India’s Telemedicine

Take telemedicine for example, an approach to getting information to remote populations at a fraction of the cost of circuit-riding physicians. In India, 70% of the population lives in rural areas, but only 3% of the country’s specialist physicians practice in those areas. A nonprofit called World Health Partners (WHP) is working to bridge the gap by identifying informal health providers at the village level and using live streaming over the internet to connect them to highly qualified specialists far away. These lay workers, compensated through consultation fees and a reasonable mark up on drugs sold, measure blood pressure, temperature, heart rate, respiratory rate, and can assess EKGs and transmit the results directly to the specialist physicians.

The University of California at Berkeley has studied the program and reported a dramatic increase in access to reproductive health services among six million villagers at a cost of $5.84 per adult for a couple of years protection from pregnancy. Perhaps the most important lesson for the U.S. in WHP’s telemedicine initiatives in India is its approach to scale. Rather than implementing a program and figuring out later how it might be brought to very large numbers of people, WHP is building scalability into the design through low-cost approaches, and a reliance on for-profit rural practitioners — effectively working with the private sector to build a new market for preventative health.

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    A collaboration of the editors of Harvard Business Review and the New England Journal of Medicine, exploring best practices for improving patient outcomes while reducing costs.

Brazil’s Integration of Lay Health Workers

More deeply integrating lay workers into our health system offers another path to lowering costs and broadening the reach of preventative health care. Most nations, including the U.S., make some use of lay or community health workers, but Brazil is notable for the scale at which it does this, and its success in integrating such workers into its larger healthcare system. A recent Johns Hopkins study notes that Brazil now deploys over 220,000 Community Health Agents (CHAs) to reach more than half of its 200 million residents. They work as members of health teams, including at least one doctor, one nurse, an assistant nurse and six CHAs to serve approximately 1,000 families. All the team members are salaried, full-time employees, and the CHAs must live in the communities they serve, promoting and delivering preventative health practices such as breastfeeding, prenatal care, immunizations, and screening for diseases including HIV and tuberculosis. In tandem with this approach, Brazil now has one of the most rapidly declining childhood mortality rates in the world, and has made striking gains in immunization coverage and other measures of preventive health addressed by the CHAs.

While the U.S., too, has some promising community health worker models, such as “health coaches” at AtlantiCare in Atlantic City, N.J., and “ promotoras” at Latino Health Access in Santa Ana, CA, Brazil’s experience offers us a path to scale, one that no longer views community health workers as “non-traditional,” but integrates them into the healthcare system, and, ultimately, pays for them in the same way that care in clinical settings is remunerated.

Mindset Before Model

 The “market” for preventive services is almost nothing like the market for automobiles; we can’t rely on market forces alone to increase the flow of global preventive health innovations into the U.S. But we should recall that Japanese automakers had been innovating for a long time before American automakers got serious about exploring and adapting these innovations. The first change may need to be mindset: expanding our view of where we might find powerful models for improving preventive health in the U.S., expanding our idea of who should be involved in identifying, prototyping, and scaling these models, and thinking big — designing for scale — from the outset.

Nidhi Sahni is a Manager in the public health and global development practice with The Bridgespan Group, a nonprofit advisor to other nonprofits and philanthropy.

Michael Myers is Managing Director at The Rockefeller Foundationand leads its global health work.

data saving lives, EF, health market quality

RWJF: Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund

Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund.

PDF: 1789_Patel_making_sense_Medicare_phys_payment_data_release_ib

Overview

In April 2014, the Centers for Medicare and Medicaid Services released a data file containing information on Medicare payments made to physicians and other providers. Though an important achievement in promoting greater health system transparency, limitations in the data have hindered key users, including consumers, payers, and providers, from discerning meaningful information from the file. This brief outlines the significance of the data release, the limitations of the dataset, the current uses of the information, and proposals for rendering the file more meaningful for public use.